Revised Application for RJU Award
Updated on 7/15/2020

Click above link to download application


 The award Recipient is:  ______________________________________________________________________ 
 
Please engrave the plaque as follows (Please clearly print the text you would like to appear on the plaque, in 20 words or less). __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

PLEASE ALLOW 4-6 WEEKS FOR DELIVERY - WE CANNOT SHIP TO P.O. BOXES

Send this award to:  _________________________________________________________________________

Ship to Address:  ____________________________________________________________________________ Ship to City:  ______________________________  

State:  ___________  Zip Code:  ______________________

Day time Phone:  (         )____________________     Evening Phone:  (        )______________________

E-Mail Address:  ____________________________________________________________________________

District  __________          Club:  _______________________________________________________________

Date you need the award in hand:  ___________________________     RJU # if known:  __________________ 
 
Need an extra pin?  They are $5.00 each.  

Please indicate how many extra needed:  __________

MAIL THIS FORM TO: NYS & BLF PO BOX 445 GLEN HEAD, NY  11545 
 
OR 
 
EMAIL TO:  nysblf@gmail.com (you will receive a confirmation of receipt) 
 
QUESTIONS:  Call 516-445-4144 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FOR OFFICE USE ONLY 
 
 
Date Received:  ____________ Date Ordered:  ______________     Deliver by:  ___________________